Healthcare Provider Details

I. General information

NPI: 1497889752
Provider Name (Legal Business Name): PACIFIC HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KAGMAN COMMERCIAL BUILDING, UNIT D
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 505089
SAIPAN MP
96950-4314
US

V. Phone/Fax

Practice location:
  • Phone: 670-235-6175
  • Fax:
Mailing address:
  • Phone:
  • Fax: 670-323-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP001
License Number StateMP

VIII. Authorized Official

Name: DR. JOSHUA WISE
Title or Position: GENERAL MANAGER
Credential: PHARM.D.
Phone: 670-323-5000